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Signalling, status and inequities in maternal healthcare use in Punjab, Pakistan

Author

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  • Mumtaz, Zubia
  • Levay, Adrienne
  • Bhatti, Afshan
  • Salway, Sarah

Abstract

Despite rising uptake of maternal healthcare in Pakistan, inequities persist. To-date, attempts to explain and address these differentials have focused predominantly on increasing awareness, geographic and financial accessibility. However, in a context where 70% of healthcare is private sector provided, it becomes pertinent to consider the value associated with this good. This study examined patterns of maternal healthcare use across socioeconomic groups within a rural community, and the meanings and values attached to this behaviour, to provide new insight into the causes of persistent inequity. A 10-month qualitative study was conducted in rural Punjab, Pakistan in 2010/11. Data were generated using 94 in-depth interviews, 11 focus group discussions and 134 observational sessions. Twenty-one pregnant women were followed longitudinally as case studies. The village was comprised of distinct social groups organised within a caste-based hierarchy. Complex patterns of maternal healthcare use were found, linked not only to material resources but also to the apparent social status associated with particular consumption patterns. The highest social group primarily used free public sector services; their social position ensuring receipt of acceptable care. The richer members of the middle social group used a local private midwife and actively constructed this behaviour as a symbol of wealth and status. Poorer members of this group felt pressure to use the afore-mentioned midwife despite the associated financial burden. The lowest social group lacked financial resources to use private sector services and opted instead to avoid use altogether and, in cases of complications, use public services. Han, Nunes, and Dreze's (2010) model of status consumption offers insight into these unexpected usage patterns. Privatization of healthcare within highly hierarchical societies may be susceptible to status consumption, resulting in unforeseen patterns of use and persistent inequities. To-date these influences have not been widely recognised, but they deserve greater scrutiny by researchers and policy-makers given the persistence of the private sector.

Suggested Citation

  • Mumtaz, Zubia & Levay, Adrienne & Bhatti, Afshan & Salway, Sarah, 2013. "Signalling, status and inequities in maternal healthcare use in Punjab, Pakistan," Social Science & Medicine, Elsevier, vol. 94(C), pages 98-105.
    • Handle: RePEc:eee:socmed:v:94:y:2013:i:c:p:98-105
    DOI: 10.1016/j.socscimed.2013.06.013
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    References listed on IDEAS

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    1. Mumtaz, Zubia & Salway, Sarah, 2009. "Understanding gendered influences on women's reproductive health in Pakistan: Moving beyond the autonomy paradigm," Social Science & Medicine, Elsevier, vol. 68(7), pages 1349-1356, April.
    2. Nicole L. Mead & Roy F. Baumeister & Tyler F. Stillman & Catherine D. Rawn & Kathleen D. Vohs, 2011. "Social Exclusion Causes People to Spend and Consume Strategically in the Service of Affiliation," Journal of Consumer Research, Journal of Consumer Research Inc., vol. 37(5), pages 902-919.
    3. Veblen, Thorstein, 1899. "The Theory of the Leisure Class," History of Economic Thought Books, McMaster University Archive for the History of Economic Thought, number veblen1899.
    4. Naushin Mahmood & Saima Bashir, 2012. "Applying an Equity Lens to Maternal Health Care Practices in Pakistan," Working Papers id:5102, eSocialSciences.
    5. Kemal Aydin, 2006. "Social Stratification and Consumption Patterns in Turkey," Social Indicators Research: An International and Interdisciplinary Journal for Quality-of-Life Measurement, Springer, vol. 75(3), pages 463-501, February.
    6. Naushin Mahmood & Saima Bashir, 2012. "Applying an Equity Lens to Maternal Health Care Practices in Pakistan," PIDE-Working Papers 2012:83, Pakistan Institute of Development Economics.
    7. Winkvist, Anna & Akhtar, Humaira Zareen, 2000. "God should give daughters to rich families only: attitudes towards childbearing among low-income women in Punjab, Pakistan," Social Science & Medicine, Elsevier, vol. 51(1), pages 73-81, July.
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    2. Munwar Hussain Pahi & Umair Ahmed & Abdullah Zafar Sheikh & Sarfraz Ahmed Dakhan & Faiz Muhammad Khuwaja & T. Ramayah, 2020. "Leadership and Commitment to Service Quality in Pakistani Hospitals: The Contingent Role of Role Clarity," SAGE Open, , vol. 10(4), pages 21582440209, October.
    3. Phanhpakit Onphanhdala & Vanvisa Philavong & Yoshihiko Kadoya & Mostafa S. Rahim Khan, 2020. "Access to Antenatal Care in Laos: Analysis Using National Level Survey," Asian Economic Journal, East Asian Economic Association, vol. 34(3), pages 327-349, September.
    4. Fletcher-Brown, Judith & Pereira, Vijay & Nyadzayo, Munyaradzi W., 2018. "Health marketing in an emerging market: The critical role of signaling theory in breast cancer awareness," Journal of Business Research, Elsevier, vol. 86(C), pages 416-434.

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